Alpern Jonathan D, Joo Heesoo, Bahr Nathan C, Leventhal Thomas M
Infectious Disease Section, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA.
Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Open Forum Infect Dis. 2023 Mar 4;10(3):ofad118. doi: 10.1093/ofid/ofad118. eCollection 2023 Mar.
Nonadherence to antiviral therapy can lead to poor clinical outcomes among patients with chronic hepatitis B (CHB). We used a claims database to evaluate risk factors for nonadherence to antiviral therapy among commercially insured patients with CHB in the United States.
We obtained data for commercially insured adult patients with CHB prescribed entecavir or tenofovir disoproxil fumarate (TDF) in 2019. Primary outcomes were adherence to entecavir and adherence to TDF. Enrollees with a proportion of days covered (PDC) ≥80% were considered adherent. We presented adjusted odds ratios (AORs) from multivariate logistic regressions.
Eighty-three percent (n = 640) of entecavir patients were adherent, and 81% (n = 687) of TDF patients were adherent. Ninety-day supply (vs 30-day supply; AOR, 2.21; < .01), mixed supply (vs 30-day supply; AOR, 2.19; = .04), and ever using a mail order pharmacy (AOR, 1.92, = .03) were associated with adherence to entecavir. Ninety-day supply (vs 30-day supply; AOR, 2.51; < .01), mixed supply (vs 30-day supply; AOR, 1.82; = .04), and use of a high-deductible health plan (vs no high-deductible health plan; AOR, 2.29; = .01) were associated with adherence to TDF. Out-of-pocket spending of >$25 per 30-day supply of TDF was associated with reduced odds of adherence to TDF (vs <$5 per 30-day supply of TDF; AOR, 0.34; < .01).
Ninety-day and mixed-duration supplies of entecavir and TDF were associated with higher fill rates as compared with 30-day supplies among commercially insured patients with CHB.
慢性乙型肝炎（CHB）患者不坚持抗病毒治疗会导致临床预后不佳。我们利用一个索赔数据库评估了美国商业保险的CHB患者不坚持抗病毒治疗的风险因素。
我们获取了2019年商业保险的成年CHB患者中，处方恩替卡韦或替诺福韦酯（TDF）的数据。主要结局是对恩替卡韦的依从性和对TDF的依从性。覆盖天数比例（PDC）≥80%的入组者被视为依从。我们展示了多因素逻辑回归的校正比值比（AOR）。
83%（n = 640）的恩替卡韦患者依从，81%（n = 687）的TDF患者依从。90天供应量（与30天供应量相比；AOR，2.21；P <.01）、混合供应量（与30天供应量相比；AOR，2.19；P =.04）以及曾使用邮购药房（AOR，1.92，P =.03）与恩替卡韦依从性相关。90天供应量（与30天供应量相比；AOR，2.51；P <.01）、混合供应量（与30天供应量相比；AOR，1.82；P =.04）以及使用高免赔额健康保险计划（与无高免赔额健康保险计划相比；AOR，2.29；P =.01）与TDF依从性相关。每30天TDF供应的自付费用>25美元与TDF依从性降低几率相关（与每30天TDF供应<5美元相比；AOR，0.34；P <.01）。
与30天供应量相比，90天和混合时长供应量的恩替卡韦和TDF在商业保险的CHB患者中与更高的配药率相关。
